Dossia Off to Slow Start with Personal Electronic Health Records

Dossia is nearly three years from launching to provide electronic personal health records for major U.S. employers. And though the vision to provide employees of self-insured companies with a secure and portable electronic record of their health information is still alive, so far one company is offering the records to its workers.

The Cambridge, MA-based organization, which operates as a nonprofit, had a well-publicized launch in December 2006 and the support of founding members Applied Materials, BP America, Intel, Pitney Bowes, and Wal-Mart. The hope was, and still is, that the personal electronic records would lower healthcare costs and improve health of users. But only one of the 10 major U.S. employers that have pledged to support the development of Dossia’s health records system, Wal-Mart, has actually adopted the technology for its workers and their dependents.

Dossia has recently solidified its leadership team recently as it takes steps to drive further adoption of the personal health record system, which is based on the Indivo personal health platform (PHP) developed at Children’s Hospital in Boston. Colin Evans, Dossia’s president and CEO, was put on the payroll last month, having previously served the nonprofit outfit while technically an employee of the digital health group of computer chip giant Intel. Evans’ former Intel colleague, Steve Munini, the chief operating officer of Dossia, has also transitioned from Intel’s to Dossia’s payroll.

Evans said last week that he expects Intel, where the idea for Dossia originated, to open the personal health record system to its employees in early 2010. A total of four other founding employers will be ready to deploy the system within the next three months, he says. “My major goal is to get everybody from the founder group to get implemented,” Evans said. There are now only tens of thousands of users of the Dossia record system today, most of them employees of Wal-Mart, which deployed the system for its workers in fall 2008, he said.

Why haven’t the other corporate members adopted the technology? “They really want to see Wal-Mart go first and test the system before they let people in,” Evans said, adding that the system has undergone technical upgrades. To be fair, Dossia isn’t the only provider of personal health records that has faced adoption challenges. Last month I took a look at Google Health and Microsoft HealthVault, both of which were launched after Dossia and have yet to reach a mainstream audience.

“The current health care financing [system] combined with our societal views on health and illness do not create any meaningful incentives for consumers devote the time and energy necessary to engage with personal health records,” Joseph Kvedar, a physician and director of Boston’s Center for Connected Health, told me in an e-mail.

The Center for Connected Health—which is Boston-based Partners Healthcare’s developer and provider of technology and services to enable the delivery of care to patients outside of hospitals and other traditional clinical settings—is developing its own application for diabetic patients to use on the Microsoft HealthVault platform. Kvedar said that electronic records are potentially very useful, but he prescribed a combination of consumer education, employer participation, and new incentives for healthcare providers to use the records as a cure for the problem of slow adoption.

There may be more to Dossia’s slow progress than just its members’ wait-and-see attitude, though. John Moore, a healthcare IT analyst at Chilmark Research, wrote on his Cambridge firm’s blog that Dossia has had to update the Indivo platform to meet the needs of large enterprises. Also, Dossia suffered delays due to an ugly breakup with its original technology partner, Omnimedix, which resulted in a legal battle between the two organizations in 2007, according to this InformationWeek article.

To make its platform more appealing to a wide range of patients, Dossia released open source code and standards in June to improve the ability of independent software vendors to develop healthcare applications for its platform. (Google’s and Microsoft’s health record systems also have open platforms.) Dossia has previously announced such healthcare software providers as eClinicalWorks, HealthTrio, MediKeeper, and Metavante have been working on apps for its platform. Evans said that there were now about 25 software outfits that are part of Dossia’s ecosystem of app developers. The group has also developed its platform to integrate WebMD information and services for end-users from Wal-Mart.

Evans said that a key plus of the Dossia platform is that users can authorize the group to populate their records with health information from their insurers, something that Microsoft HealthVault and Google Health doesn’t handle for their users. (Despite this point of differentiation and some others, Moore wrote in his blog post that his firm “struggles to understand what the value proposition is an employer to adopt the Dossia platform for their employees.”)

Dossia has operated thus far with lots of management help from Intel and other member companies as well as about $15 million from the $1.5 million that each of the nonprofit group’s 10 members have contributed to support its mission. Evans said that he is working on recruiting more employers, and the organization also plans to support itself by collecting service fee from employers for each worker who establishes a personal health record with Dossia.

The coming months will tell use if Intel and others that paid for Dossia to create a personal health record system will make an ever larger bet on the organization by deploying the technology for their workers.

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